Costing the health impacts of climate change is complex and controversial.
It is complex because of the great heterogeneity of the health impacts, which
include death, infectious disease, nutritional deprivation, and post-traumatic
stress disorders. It is controversial because of difficulties in assigning money
values to a diverse range of health deficits, doing so across varied cultures
and economies, and taking account of the full "stream" of health impacts
into the future (with appropriate time-discounting). During the 1990s, an attempt
was made to develop a more standardized approach to measurement of the population
health deficit by combining chronic illness or disability and premature death,
via weighting procedures, into an integrated indexthe Disability-Adjusted
Life Year (Murray, 1994; Murray and Lopez, 1996).

To date, however, there is negligible scientific literature on the population
burden of disease attributable to current or future climate change. There is
no such literature on the DALY-based impact. Hence, there is no basis for making
overall estimates of the direct costs to society of the health impacts of climate
change. Nevertheless, some approximate estimations have been published of the
impacts on national economies of major infectious disease outbreaks, such as
might occur more often under conditions of climate change. For example, the
outbreak of plague-like disease in Surat, northwest India, in 1994 cost an estimated
US$3 billion in lost revenues to India alone (John, 1996; WHO, 1997). The cost
of the 1994 Dengue Haemorrhagic Fever (DHF) epidemic in Thailand was estimated
to be US$19-51 million (Sornmani, et al., 1995). The cost of the
1994 epidemic of dengue/ DHF in Puerto Rico was estimated to be US$12 million
for direct hospitalization costs alone (Rodriguez, 1997; Meltzer et al.,
1998).

9.14.2 Development, Sustainability, and Equity

The ideas of development, sustainability, and equity inform much of the content
of this chapter. It has been noted repeatedly that health impacts will tend
to occur unevenly in the world and that the impacts in poorer populations, especially
in the least-developed countries, often will be augmented by the heightened
vulnerability of those populations. That is one of several reasons whyin
today's world in which the gap between rich and poor is widening (UNDP
1999), in association with the nonredistributive character of market-dominated
global economics (McMichael and Beaglehole, 2000)new ways of redressing
the imbalance in wealth and knowledge should be found.

The chapter also notes that development on a broad frontsocial, economic,
technological, and provision of public health services and capacitiesis
crucial to a population's adaptive capacity to lessen the impacts of climate
change.

Indeed, the health of a population is a key indicator of "sustainability."
The capacity of the global population to achieve and maintain good health is
an index of how well the natural and social environments are being managed.
Wealthy local populations can afford to subsidize their health maintenance,
drawing on resources imported from elsewhere. At a global level, however, health
indicators provide a more valid indication of the extent to which the "carrying
capacity" of the biosphere is being maintained.